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Organization
BOIS FORTE RESERVATION TRIBAL GOVERNMENT
Active
Organization
BOIS FORTE RESERVATION TRIBAL GOVERNMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE CHAVERS (TRIBAL CHAIRMAN)
(218) 757-3361
Entity
Organization
Contact information
Practice address
5219 ST. JOHN DR, NETT LAKE, MN 55772
(218) 757-3650
Mailing address
5219 SAINT JOHN DR, ORR, MN 55771-8232
(218) 757-3650
(218) 757-0222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
332U00000X
Home Delivered Meals
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177515400
—
MN
01
—
63G35BO
BCBS
MN
Enumeration date
07/16/2006
Last updated
05/19/2022
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